Healthcare Provider Details

I. General information

NPI: 1992567028
Provider Name (Legal Business Name): TROY DALE WHITE II APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NE 2ND AVE
OKEECHOBEE FL
34972-2622
US

IV. Provider business mailing address

802 SW 3RD AVE
OKEECHOBEE FL
34974-5121
US

V. Phone/Fax

Practice location:
  • Phone: 863-610-1563
  • Fax:
Mailing address:
  • Phone: 863-610-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030845
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9527128
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: